Provider Demographics
NPI:1528227774
Name:AGUAYO, LETICIA
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:AGUAYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 STOCKER ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VIEW PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5118
Mailing Address - Country:US
Mailing Address - Phone:323-296-2446
Mailing Address - Fax:323-299-3159
Practice Address - Street 1:3731 STOCKER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:VIEW PARK
Practice Address - State:CA
Practice Address - Zip Code:90008-5118
Practice Address - Country:US
Practice Address - Phone:323-296-2446
Practice Address - Fax:323-299-3159
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner